Grief: Case of bereavement

Grief is a state of intense grief brought on by unfortunate events like death. It has also been linked to the emotion that people experience after enduring tremendous hardship, such as the loss of their cherished possessions due to disasters and other natural or man-made catastrophes. All people experience grief naturally, but if it isn't managed properly, it can cause further pain. When handled by a qualified expert, counseling is a useful therapy for coping with sorrow and helps those who use it find healing and wellbeing. The death of a loved one can have devastating consequences to an individual if not supported well. Individuals have different have ways of responding to grief based on their personality traits. The intensity of grief also depends on the relationship people have with the departed. It is easier to grieve a casual friend or an acquaintance than it is with a close family member. In this respect, it is vital to examine the various types of grief

Types of grief

Abbreviated grief is the kind that is short-lived. This does not mean that this type of grief is not genuine; the affected individual may receive sufficient help so as to deal with the consequences of the grief (Walter et al, 2015). An example may be a man who loses his wife; the grief may last until he finds comfort by marrying a second wife. There is the absent grief that is depicted in a person who seems not to be affected by the grief at all. This is considered a normal phase of grief in the initial stages but in begins to raise eyebrows if it goes on for an extended period of time. Men commonly put aside their sorrow so as to act strong before the family. A mother may also postpone her grieving so as to concentrate on taking care of her children.

There is also the ambiguous grief which is usually not accepted by the persons who are expected to supply comfort. This grief is usually unseen by others and therefore not considered as valid. A person who loses a favorite pet may be grieved in ways others may not understand (Boss et al, 2014, 50). They may even belittle the loss which aggravates the grief on the affected persons. Anticipatory grief happens when one is living with the anticipation of impending grief. If a person has a terminally sick relative, they may suffer bereavement of anticipating the loss; this is worsened if the sickness persists for a long time.

People also commonly suffer chronic bereavement when their sense of loss persists over a long period of time. The feelings remain as fresh as when the incident happened. People who had close dependence on the deceased are more likely to experience this type of grief. This type also happens when death happens after a tragic happening like an accident. Complicated grief happens when the bereavement fails to heal with time and instead, it worsens. Affected persons may show symptoms of this type of grief by avoiding reminders, maintaining solitude and displaying denial. Unless such people receive timely therapy, they can sink into mental illness. People experience delayed grief when they do not immediately get the opportunity to go through the emotion that comes with loss. This delay may either be deliberate or it may be occasioned by pre-occupation with other aspects related to the grief. Persons who witness violent deaths may develop numbness of feeling and may avoid even attending the funeral of the killed person. In that manner, they do not get closure and the grieving is postponed.

Disenfranchised grief is the kind that happens where societal rules prohibit certain forms of expression. Mothers may experience this grief when they lose their unborn children, this can be the same experience for a mother after procuring an abortion. In suicide cases, someone may fear retribution for inappropriate actions or words and may bottle in their feelings (Boss et al, 2014, 133). Closely related to this is inhibited grieving where a person exhibits less than the expected signs of mourning. This is usually seen among people who consider expressions of grief as a sign of weakness. Such people tend to withdraw emotionally as they deal with inhibited grief.

Case of bereavement

Handling of grief of a loved one is a delicate case because it is never predictable how the bereaved will respond. Sigmund Freud was of the view that the bereaved persons should “let go” of the feelings of loss and put it behind them. Freud prescribed a formula through which a bereaved person can achieve a detachment from the deceased; understanding and accepting the loss, withdrawing one’s attachment to and identification with the deceased and resuming one’s emotional life and establishing new relationships (Nardi, 2016, 100). This formula acknowledges that the deceased person has already left and should be placed in the past where he/she belongs. Grieving persons may consider this to be a radical approach especially if the grieving persons enjoyed a close relationship with the deceased. Such mourners will still maintain an attachment with the deceased by maintaining their portraits in their living rooms and holding annual commemoration days in their honor.

A unique case of bereavement is the death of a parent especially when the bereaved has seen them undergo painful suffering for a long period of time. This may be caused by a terminal sickness that continually robs them the senses that make them functional. The bereaved person in this case usually goes through great emotional turmoil as they see their parent in a helpless state. By the time the death is happening, they may not depict the symptoms commonly associated with grief and people may not understand them. To casual observers, the bereaved may look uncaring for the deceased. The emotional baggage they may have carried throughout the elongated period of sickness may have in a way prepared such persons for the loss. However, it must not be mistaken to mean that such a person has already dealt with the bereavement, it is a temporary stage and the actual bereavement may be delayed.

Stages of bereavement

Kubler-Ross understood these emotions when postulated the five stages of loss. The first stage, according to Kubler, is denial where the bereaved responds through “not me” responses. This stage is closely followed by anger. At this stage, the person gets through a “why me” process before getting to bargaining. In response to bargaining, the bereaved gets through the “yes me, but…” motions. He then goes through depression and finally arrives at a place of acceptance. This well resonates with individuals especially in cultural settings where funeral rites linger on for many days. Traditional communities have structures through which they support families that have suffered loss of their loved ones. Such rites may extend to weeks and even months. By surrounding the family from the day of bereavement, such communities acknowledge that dealing with grief is a long process. However, clinicians and researchers have not bought into Kubler-Ross’ theory because it has not been supported by research (Smaldone, 2013, 450).

Jean Piaget was involved in early study of cognitive behavior in children. His study reveals that children have a mental structure so basic and it is upon this that further learning and knowledge emanates. This thinking is contrary to the previous views that children were less competent as thinkers than adults (Beilin et al, 2013, 100). His study revealed that children think in strikingly different ways in comparison to adults. Lawrence Kohlberg developed on Piaget’s work by coming up with stages of moral development; the pre-conventional, conventional and post-conventional stages. These stages were further divided into two stages each bringing the total to six. Kohlberg observed that the sense of morality of a child is externally controlled during the pre-conventional stage. A child’s minders like parents, teachers and others inform the rules which a child accepts at this stage. During the conventional stage however, the sense of morality of an individual in tethered to societal relationships. As much as children continue to instructions from authority figures, they do it in realization that it is necessary to achieve positive relationships and ensure societal order. Kohlberg continues to say that a person’s sense of morality is informed more by abstract values and principles during the post-conventional period. At this stage, people believe that some laws are not just and should either be changed or be eliminated.

Kohlberg’s theory may be used by Clinicians and other professionals to segment their therapy based on the age of the bereaved person. This theory has however been seen to be inconsistent because it tasks the therapists to ensure that their sense of judgment is perfect regarding the perceived stage of their clients (Stroebe M. et al, 2017, 120) This is a hard task because the development of an individual is dependent upon various factors including environment, culture and gender. It is also likely that a therapist will be biased against clients from different races and cultural settings (Loewenthal, 2015, 218).

Sigmund Freud has influenced our thinking on behavior right from the words commonly used in America. Words like denial, repression, libido et cetera formed part of Freud’s vocabulary. In his contribution, he said that when we explain our conduct to ourselves and to others, we often do not tell the truth. Freud believed that while human beings are not necessarily deceivers, they are more gullible to self-deception. He is famed for being the founding father of Psychoanalysis which is a method of mental illness treatment. This was as a result of his quest to delve beneath the veil of elaborate camouflage which is often concealed beneath structures as well as processes of personality. Freud wished to see his clients talking freely on account of their symptoms in relation to what they were thinking about.

Counseling

Counseling is the process of providing assistance and guidance in order to resolve personal, social or psychological difficulties especially by a professional. Life has a myriad challenges which require individuals to seek psycho-social support from various corners. Trained counselors assist such people face situations in their lives with confidence (Anderson R. et al, 2015, 360) Counseling requires plenty of time to listen to and allow the client to vent out whatever bothers them. In this regard, counseling requires a high level of trust. Apart from professional counselors, various persons can offer counseling services to people that commonly approach them. Friends provide a kind of counseling when people are faced with serious challenges. This is because they are the first contact before professional services are sought, if that happens at all. It is however important to note that counseling is not giving advice or passing a judgment. Counselors must go beyond advising their clients to empowering them to take charge of situations that confront them (Mcleod, 2013, 90). Counselors must also never try to solve problem for the client. They should also desist from any form of emotional engagement with the person seeking their services. This service must remain strictly professional.

A good counselor will be one that is well armed with listening skills; they will allow the client to talk more and be keen to note the tone of what the client is saying as well as omissions. Consequently, the counselor will need to seek for clarification, engage the client in reflection and practice effective questioning skills (Mcleod, 2013, 120). As much as counselors are ethically proscribed from getting emotionally involved with their clients, they need to make an effort and build a healthy level of rapport with them. In addition, they need to practice empathy; they need to ask proper questions which will allow the client obtain positive conclusions.

Counseling mostly involves talking and as such, a counselor needs to perfect their communication skills in order to effectively engage a client. They first of all need to use a language which the client can understand (Hodgson J. et al, 2014, 118). This does not only restrict itself to the lingua franca of the client. The language must be customized to the age and social standing of the client (Midwinter et al, 2015, 14). A youthful client might be conversant with slang but elderly people will prefer being addressed in clear conventional language. Improper language might cause a client to form an attitude about the therapist and thereby mentally blocking them from the exercise; this is a disaster in the counseling journey. The therapist must also show genuine interest in the client (Kwong, 2014, 54). Basically, they should remember their name and the names of the places that are of importance to the client. Such places may have been mentioned in previous sessions. Most importantly, the therapist should remember the name of the problem that the client has shared. It shows a bad signal when the counselor has to keep referring to the client’s file to confirm names.

A good counselor gives sufficient time to the client to express themselves, however in doing so; the professional should not remain a passive observer in the process. He can display his engagement in the process by using encouraging statements. These statements should not interfere with the flow of what the client is narrating and they should also not be mechanical (Nelson-Jones, 2015, 131). A skilled counselor will make the client comfortable to share their experiences openly thereby allowing them internal relief. Counselors must also give information. They should ensure that they supply the client with the requisite information that will help them to make informed decisions. Therapists should never give into the temptation of advising the client; the client has the responsibility of summoning energies within themselves to confront their problems (Mearms et al, 2013). The therapist’s task is to help the client to galvanize these energies.

In grief situations, tension is likely to build up thus subjecting the parties to some awkward scenarios. To defuse these tensions, a good counselor can employ a sense of humor (Kopp R. R., 2013, 70). The humor must be innocent so that the client doesn’t read sarcasm. The counselor could veer the conversation off to some unrelated topic that breeds laughter. The two can then laugh together before the counselor carefully drives the conversation back on course. Counselors should take caution to speak slowly, softly and clearly. They should avoid scenarios where the client continuously seeks clarification about something they have not said clearly. Clarity of speech is a sign of confidence and the professional must strive to display this quality to the client.





Types of psychotherapy

Psychotherapy is a roadmap that guides psychologists as they walk with their clients as they seek solutions to their problems. Psychotherapy approaches are divided into five areas.

The first category is psychoanalysis and psychodynamic therapies. It aims at altering problematic behaviors, thoughts and feelings through discovery of their underlying motivations and meanings. Through this approach, a close working relationship between the professional and the patient is established. Clients explore their interactions in the relationship and learn about themselves (Mulder et al, 2017, 45). This therapy is mostly identified with Sigmund Freud but has been applied by other scholars including Ivan Pavlov. Ivan enriched behavioral therapy through his discovery of classical conditioning. Through the famous experiment involving dogs, Pavlov discovered the aspect of associative learning (Labrenz et al, 2015, 220). Human beings have been seen to display such predictability when subjected to certain stimuli. When people are given the right incentive, they easily adopt new forms of behavior.

Cognitive therapy is an approach that emphasizes what people think as opposed to what they do. Therapists that follow this approach believe that it is dysfunctional thinking that leads to emotions that are dysfunctional and ultimately dysfunctional behaviors. They focus on changing the behaviors of people by changing the way they think. This therapy well agrees subtly with the way certain forms of education are administered to people; they are geared more to influencing the way people think. Religious education, to a large extent, follows this route so as to direct people towards favorable thoughts and deeds. Leading scholars in cognitive therapy include Albert Ellis and Aaron Beck. Cognitive therapy is mostly short-term and deals with issues ranging from fear, panic and eating disorders to marital problems and depression. Its focus is on how a person thinks, behaves and communicates

The Humanistic therapy lays emphasis on the capacity of people to make rational choices and grow to their maximum potential (Rubin J. A., 2016, 85). Leading philosophers in this approach including Jean-Paul Satre and Martin Buber believe in respect and concern for others. Under this approach, there is the client centered therapy that goes against the thinking that therapists should be the authority on their clients’ inner feelings. They rather assist the client to change by stressing on their concern, interest and care (Waterman A. S, 2013, 23). The other theme is the Gestalt therapy which lays emphasis on “Organismic holism”. It is the philosophy of being aware here and now and accepting responsibility for one self. Lastly under this therapy is the existential therapy that approaches the patient from a premise of free will, self-determination and the pursuit for meaning.

The integrative or holistic therapy is a blend of the various approaches. Therapists do not bind themselves to one approach. In doing this, the therapists customize their treatment to specific clients (Ramsay et al. 2014, 56). This gives them the free will such that they are able to alter their strategies as they observe the client.

Narrative therapy and bereavement

Narrative therapy is a technique used in counseling where the professional attempts to distinguish the person from the problem they are facing (Elderton A. et al, 2014, 102). With this technique, the problem is dealt with separately without connecting it to the personality of the client. They guide the client to activate skill within them so that they can handle the situations that confront them instead of sinking into depression thinking that there is something wrong with them (Roe D. et al, 2014, 43). When it comes to bereavement, it is comforting to learn that grief is an occurrence that has happened to them and they do not have to internalize it (Lopes et al, 2014, 320). This means that they see it as an occurrence common to all people regardless of their personality orientation or other factors in their individual nature. Grief can weigh heavily down on an individual and they may begin to think that they have contributed to the state of things. Parents who have been bereaved of their children many blame themselves if the child died of a sickness that they think was preventable (Hayes T, 2013, 54). They may begin to imagine that had they taken extra care, the death could not have occurred. Narrative therapy externalizes these feelings and the healing process is expedited.

Given the weight that grief puts on an individual, the role of a counselor will have to go beyond the counseling room; he must develop a professional personal contact with the grieving person (Jordan M, 2014, 88). For these personal applications to be effective there are several guidelines that need to be followed.

The therapist must develop a collaborative stance with the client. This means that he must be willing to be flexible regarding the homework he gives based on the client’s feedback. The professional must be alive to the client’s unique circumstance. The therapist must bring to bear his/her creativity to bear taking into account the needs and the resources of the client (Lopes et al, 2014, 412). The client’s resistance to a particular suggestion by a therapist must also be respected. The counselor remains an outsider in this relationship and should recognize that the client’s refusal to undertake a particular homework might be for their good. In fact, such resistance could end up being the topic for further discussion that may bring out invaluable insights into the extent of the client’s loss.

The client’s privacy must also be respected so that the therapist doesn’t unnecessarily prod into details he/she is hesitant to share. At the beginning of a counseling journey, a client may reserve certain reactions (Hara K. M. et al, 2015, 43). This should be taken in the right perspective by the professional. With time after the client has gained sufficient confidence, they are able to share the experiences and reactions with others in a free environment. The therapist should also integrate the counseling process with homework (Tanner V., 2016, 77). This can happen seamlessly when he asks the client how the homework was when they meet for the next session. The clients can, in creative ways, be asked to share relevant portions of the exercises with the counselor (Trower P. et al 2015, 38). When this is done at the client’s pace, a sense of confidence ultimately arises and the therapist achieves the requisite rapport for direct client sharing in later sessions.

The therapist must also acknowledge that grieving takes time and as such, they should never rush the process with activities that the client must do (Rahman K. H., 2016, 43). The emphasis should be on “being” as opposed to “doing”. As the process progresses, the client may not even be given exercises to do.

Grieving persons tend to go through varied emotions having lost someone or something (Stets et al, 2014, 70). Such persons yearn to have back what they have lost although they know that it is impossible. The narrative therapy is helpful in helping people to move away from the thinking that grief is private and not a societal problem (Adelufosi et al, 2017, 117). We all have the duty to assist the grieving person to resume normalcy. Because not all grieving persons do not have the privilege of sitting with a counselor, society can be sensitized to develop structures for narrative counseling (Neimeyer et al, 2014, 44). By staying often with the bereaved and engaging them in common talk, they begin to slowly regain their emotional space in society. It can be very refreshing if close friends and relatives stay with the bereaved person and engage them in conversation that they are accustomed to (Kentish-Bernes et al, 2016, 120). They can manage to do away with the ‘professional’ tag and naturally weave the grieving person back to ordinary life. However, close acquaintances that are not trained may aggravate the grief more if they are not sensitive of the various stages of grief (Joyce P., 2014, 23). For example they may keep the person in continuous conversations and not be sensitive to times when to leave the person alone.

In dealing with a professional counselor, the ‘stranger’ tag may be beneficial for a client. This is because the counselor may have very few details about the previous life of the client. The only information they will gain is the one the client volunteers to give (Dyregrov et al, 2013, 54). This sets the client at peace and prevents any form of prejudice on the part of the counselor. They are likely to engage the counselor even in details that they consider embarrassing in their lives and this may be the key to their recovery (Khan R. et al, 2015, 65). On the flipside, the counselor in this case solely depends upon their professional training to navigate into the feelings and emotions of the client (Freedman, 2016, 210, 67). However, an intimate friend or relative has gained familiarity with the grieving person with time. Although not professional, such a close person will have the advantage of having mastered the attitudes and dispositions of the grieving person (Nicoll, 2013, 90). As such, they can easily guide and caution them by virtue of familiarity.

Narrative therapy has been questioned on the basis of ethics (Baldwin C., 2015, 39). In their quest to engage the client and integrate them to the life before the grief, therapists stand on the border line of infringing privacy rights (Baugham et al, 2014, 74). This may be seen when documents which have previously been private like certificates and permits are brought to the fore as caseworkers come together to share their experiences with the client in therapy. Given that privacy is one of the solemn principles of narrative therapy, counselors must ensure that they protect their clients from public exposure (Kwapong et al, 2014, 50).

Conclusion

Bereavement through loss of a loved one can be a devastating experience which may alter the course of a person’s life completely. Depending on the relationship enjoyed with the deceased person and the personality of the bereaved, one can easily give into depressing thoughts and lose the functionality of their senses. Good counseling services ensure that that such secondary suffering is minimized and individuals are helped to regain their place in the family and society at large after bidding farewell to a loved one. This will ensure that we have healthy individuals who will be an asset to society towards progress.

















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